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TOPEKA, Kan. - The memory still bothers Ken Keller: A panicked ambulance crew had a critically ill patient, but the man weighed more than 1,000 pounds and could not fit inside the vehicle. And the stretcher wasn't sturdy enough to hold him. The crew offered an idea to Keller, who was then an investigator with the Kansas Board of Emergency Medical Services. Could they use a forklift to load the man  bed and all  onto a flatbed truck? Keller agreed: There was no other choice. "I'm sure it was terribly embarrassing to be in his own bed, riding on the back of a flatbed with straps tying him down, going to the hospital, and then have a forklift at the hospital unload him," Keller said. "In order for these systems to survive and continue to provide their service, there has to be some way to recover those costs," said Jim Buell, a director at the American Ambulance Association.

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Heavy burden Transporting extremely heavy people costs about 2 1/2 times as much as normal-weight patients. It takes more time to move them and requires three to four times more crew members, who often must use expensive specialty equipment, Buell said. Keller, now an operations manager for the American Medical Response unit in Topeka, successfully petitioned the Shawnee County Commission last summer to raise ambulance fees from $629 to $1,172 for critical-care patients and people who are 500 pounds or heavier. In Colorado Springs, Colo., and the Nebraska cities of Omaha and Lincoln, the fees are $1,421 for an extremely obese patient, compared with $758 for a typical patient. Before those ambulances had heavy-duty equipment, crews just had to make do, often calling in burly firefighters to help lift patients.

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"I've heard stories of people moved by U-Haul trucks and sides of mobile homes having to be removed to move patients out, things of that nature," said Ted Sayer, a general manager for the American Medical Response unit. The Centers for Disease Control and Prevention has long said that nearly a third of Americans are obese. About 5 percent of the population is morbidly obese, meaning they are more than 100 pounds heavier than their ideal weight.

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I have no problem with EMS units charging more to transport obese patients. They spend a small fortune to get an ambulance retrofitted to move those lard asses. It has to be recouped some how. It's ridiculous that we have to adapt everything because they can't stop eating. I mean seriously, when you get to be 400 lbs. doesn't a bell go off in your head?

The concept of the ambulance is that someone, a person in our community, maybe a neighbor, a friend, a family member, perhaps even ourselves is in such medical distress that immediate action is necessary. To accomplish this we equip medical personnel with training and machinery. We empower these medical personnel with extraordinary legal rights to break and enter homes, administer medical service, to exceed speed limits, and we hold those who do not yield to these vehicles to be breaking the law. At airports life flights get first priority taking-off and landing and we clear air space to speed them on their way. We allow these vehicles to be adorned with signs, flashing lights, and sirens to alert other people that someone is so close to death that we are setting-aside usual law in the hope that we can bring someone to a hospital as quickly as we can.

These services are, in short, a beautiful admission by society that we place the preservation of life as one of our highest priorities, cost be damned.

At any point in time, someone may need EMS to assist them and it doesn't matter if you're the healthiest person on the planet. They are there around the clock to assist us in our greatest hour of need. Not everyone avails themselves of all public services but I think we are all very comforted at knowing that there are EMS, police, and fire personnel to help us at a moment's notice should our lives come into disaster. It's a way a civilized community acknowledges that even for the least of us, we are still a community and value each other for who we are, not what we can pay.

To charge people for this denies the very principle upon which EMS was founded and, like other health care issues, descends into the realm of pay-for-life. If you can afford it, you live. If you can't afford it, you may well die.

And as for the morbidly obese, I know about a million people who could easily stand to lose a few pounds and find it the most difficult thing in the world despite the fact they exercise and eat properly. I can't imagine how difficult it must be for someone who is morbidly obese. If you have a few extra pounds and can't lose it, you're in no more position to complain than someone who weighs 400 pounds. Obesity is a complex issue which has as much to do with psychology, physiology, societal revulsion to obesity, and diet as with, "get off the couch and stop eating so much." These people are poster children for why health care in the US is so bad. They receive little or no medical care and there are no programs designed to target their very specific needs. As a result, like so much with American health care, they get no attention until their problem becomes so big (pun intended) that they make the nightly news freak show story (itself an incentive for the morbidly obese to avoid public exposure) and require hundreds of thousands of dollars in public care to keep them alive and/or reduce their weight.

It is messed up, but it's also just business. To move 3,000lbs worth of stuff will inevitably cost more than half of that.

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Our value as humans should not be measured in monetary costs at a public level. Utilitarianism is an unethical basis for a society and even Bentham admitted as such. Same goes for oligarchy and aristocracy.

The best part about aristocracy though is that they tend to lose their heads when the shit hits the fan.

My apologies to the Marquis and other real aristocrats who visit this board for that comment. It was not meant with malice.

These services are, in short, a beautiful admission by society that we place the preservation of life as one of our highest priorities, cost be damned.

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Huh? I've never lived anywhere that an ambulance ride was free. Did you not read the part that said average or normal sized people pay a fee as well? This is no different than charging an obese person for 2 seats on an airplane.

At any point in time, someone may need EMS to assist them and it doesn't matter if you're the healthiest person on the planet. They are there around the clock to assist us in our greatest hour of need. Not everyone avails themselves of all public services but I think we are all very comforted at knowing that there are EMS, police, and fire personnel to help us at a moment's notice should our lives come into disaster. It's a way a civilized community acknowledges that even for the least of us, we are still a community and value each other for who we are, not what we can pay.

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Here's the thing. I have often lived in small rural areas. It is not unforseeable that I could have a small fire at my house and call the fire dept. only to have them arrive too late to save my home because half the volunteer fire department had been called to a home that they had to cut the side wall out of with a sawz-all to get an 800 lb. man to the hospital. :angryfire2:

To charge people for this denies the very principle upon which EMS was founded and, like other health care issues, descends into the realm of pay-for-life. If you can afford it, you live. If you can't afford it, you may well die.

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Okay, first of all it's not like these people will be denied healthcare, treatment, or transit if they are morbidly obese. The EMS people do not ask for payment up front. So erase the picture in your head of an 800 lb. woman writing a check on her boobs because she can't see or reach her lap.

And as for the morbidly obese, I know about a million people who could easily stand to lose a few pounds and find it the most difficult thing in the world despite the fact they exercise and eat properly. I can't imagine how difficult it must be for someone who is morbidly obese. If you have a few extra pounds and can't lose it, you're in no more position to complain than someone who weighs 400 pounds. Obesity is a complex issue which has as much to do with psychology, physiology, societal revulsion to obesity, and diet as with, "get off the couch and stop eating so much." These people are poster children for why health care in the US is so bad. They receive little or no medical care and there are no programs designed to target their very specific needs. As a result, like so much with American health care, they get no attention until their problem becomes so big (pun intended) that they make the nightly news freak show story (itself an incentive for the morbidly obese to avoid public exposure) and require hundreds of thousands of dollars in public care to keep them alive and/or reduce their weight.

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I am aware it's not as simple as put down the Pringles. By the time you become bedridden from obesity someone in the home is enabling you and bringing you mass quantities of unhealthyfood. They are equally as sick IMO.

Someone else rightly pointed out in another thread that it's time we as a society evolved beyond the archaic notion that medical care is the sole purview of the wealthy and privileged. We also once believed that blacks weren't people and women didn't rate a vote.

But until we reach that point, Fatty McLardass should have to pony up the additional costs associated with her transportation.

Why? I have family and friends who are morbidly obese and would end up receiving a bill from an ambulance company if this was made a nationwide thing.

And if wishes were horses beggars would ride.

*SNIP*Huh? I've never lived anywhere that an ambulance ride was free. Did you not read the part that said average or normal sized people pay a fee as well? This is no different than charging an obese person for 2 seats on an airplane.

Here's the thing. I have often lived in small rural areas. It is not unforseeable that I could have a small fire at my house and call the fire dept. only to have them arrive too late to save my home because half the volunteer fire department had been called to a home that they had to cut the side wall out of with a sawz-all to get an 800 lb. man to the hospital. :angryfire2:

Okay, first of all it's not like these people will be denied healthcare, treatment, or transit if they are morbidly obese. The EMS people do not ask for payment up front. So erase the picture in your head of an 800 lb. woman writing a check on her boobs because she can't see or reach her lap.

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It is different because the morbidly obese are being penalized for their affliction, unlike every other ambulance customer.

And just how is not being asked to pay up-front any consolation? You're still paying!

Let's hope your house doesn't catch on fire because you may as well justify the ambulance charging more for the obese by saying that the fire department should charge for service based upon the size of the structure they're trying to put out. A medical emergency is a medical emergency whether a person is 80 or 800 lbs. Either way, that particular ambulance won't be able to collect you any faster if you need it while it's in service elsewhere.

If you don't think people are denied care based upon their ability to pay, you're mistaken.

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I don't think people pay for ambulances here but I can see where in countries that do charge, obese people are going to have to be charged more.

Maybe it will give some of those morbidly obese people some incentive to lose weight. It's hard work becoming morbidly obese...it takes work, effort, dedication.

I don't want to hear "it's genetic" either. The bottom line is, if you don't eat, you don't put on weight. Similarly if you can control what you eat and eat within normal parameters then you cannot possibly become obese.

Being morbidly obese is not an "affliction" it is something that people bring on themselves and is entirely avoidable.

In a for profit health care system everyone is "penalized for their affliction." People are always charged based on the service used, If you require an MRI that's what you pay for. If it takes 9 people and three types of vehicle to move you because of your size why would that be different?

I need to ask you as an American are you in favour of socialized medicine?

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The cost of the ride itself should not be based on weight. If we start on weight, what next? The unfortunate who lives up 5 flights of stairs? Are they to be hit with an additional fifty dollars per flight or maybe just deny them service? Further, all ambulances should be structured for the larger bodied person. And is a 6'8" person going to receive less flack because their 400 pounds is spread out more than on a person who is 5'4"?

And what about the patient who lives in an elevator building, or on the ground floor and weighs only 100 pounds (or less) or the one who can get in the ambulance on their own? Shouldn't they be given a discount over the person who is unconscious and weighs 150 pounds? Tier billing, that's what you are proposing.

If special equipment is needed, such as the forklift, then by all means charge them for that. Of course, considering their weight, they may not be employed due to health reasons, which often go with the weight and so the cost will revert back to the taxpayer anyway.

I have been charged more than $400.00 for a 3 or 4 block ambulance ride. Are you honestly going to say that they're losing money when charging such exorbitant amounts?

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Either charge them extra or let them die...that's pretty much what it comes down to. If they can afford all that food (how the hell do they anyways? If they're too fat to work, who's buying all that food? seriously...) they should be able to afford the fat tax.

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There is nothing new about being charged for and ambulance your insurance company has been paying for it for a long time. Unless you belong to an ambulance association someone will get a bill, and if 2 ambulances show up and you get in one you will probably get a bill for both, locally its like 350 dollars. I think whats terrible is someone getting go heavy that they can no longer get to a doctor on there own means.

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I can Understand and respect Jason's point of view, but Let's not forget that there are other lives that are at risk too.

For example, if a fire breaks out, and 15 firemen have to go in to save 1 person, that's a 15 person risk to save someone that's just too damn obese.

Someone has to pay for the extra services, and that's exactly what they are doing.
How is this different than having to pay for a specially built re-inforced bed to sleep on? Or Special Clothes, or Special in house care, etc etc.

I never understood why people allow themselves to get that big.
If they want to be that fat - then let them pay the price.

I'll never forget the 4 that walked into Tony's restaraunt here. They had to go in the side doors - sideways to fit. The others helped tuck the fat in on each so they could get through the door.
What did they eat? Onion Rings Piled high, Fried foods, plates of fries, ketchup.
It was disgusting.

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There is nothing new about being charged for an ambulance your insurance company has been paying for it for a long time. Unless you belong to an ambulance association someone will get a bill, and if 2 ambulances show up and you get in one you will probably get a bill for both, locally its like 350 dollars. I think whats terrible is someone getting so heavy that they can no longer get to a doctor on there own means.

Either charge them extra or let them die...that's pretty much what it comes down to. If they can afford all that food (how the hell do they anyways? If they're too fat to work, who's buying all that food? seriously...) they should be able to afford the fat tax.

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Harshly said but yes, I agree. I understand most are on disability, but that does not pay very well. It certainly doesn't pay enough to eat as much as they appear to eat.

The cost of the ride itself should not be based on weight. If we start on weight, what next?

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Why the heck not? Seriously, I pay extra for "tall womens" clothes. I know places like Lane Bryant, Lands End, The Avenue and Eddie Bauer charge extra not just for Plus/Larger sizes but for tall sizes as well. I can't help that I have a 33" inseam, yet I pair dearly for that little bit of extra fabric so that I don't look like I am wearing floods all the time. :irked:

I have been charged more than $400.00 for a 3 or 4 block ambulance ride. Are you honestly going to say that they're losing money when charging such exorbitant amounts?

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That is because you live in NYC where everything is incredibly high priced compared to the rest of the country.

I have Hashimoto's Thyroiditis which is a severely underactive thyroid condition. I gained about 40 lbs. over an 8 month period as a result of this. Yet I am still not so big that I need to shop in plus size stores, nor do I need to buy two seats on airplane, and the one time I had to ride in an ambulance the two female EMT's were able to transport me with ease. My point, and I do have one; is that many of these 500 lb.+ people say it's a glandular problem. BULLSHIT! It may be depression or child abuse related; but it's basically a "can't stop stuffing their pie hole" problem.

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Why the heck not? Seriously, I pay extra for "tall womens" clothes. I know places like Lane Bryant, Lands End, The Avenue and Eddie Bauer charge extra not just for Plus/Larger sizes but for tall sizes as well. I can't help that I have a 33" inseam, yet I pair dearly for that little bit of extra fabric so that I don't look like I am wearing floods all the time. :irked:

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You really do not want to go to this one. I am shorter than average and am not a large guy. I pay the same for a shirt with a 15 inch collar as the person buying the one with a 16 inch collar. I pay the same price for a sweatshirt size M as the person who buys the XL. My cost for trousers with a 33 waist and a 30 inseam is the same as that for the ones with the 38 waist and 32 inseam. I pay the same for a size 9 shoe (EEEE-hey I've got wide feet) as the person purchasing the size 11.

The point here-you knew there'd be one, whether you like it or not-is that there is something known as balance. A standard cost across the board. If you go back and look at what I wrote, you will note that I am not against charging for extras. Extra worker, a forklift, a crane-tack those on. Of course as I also mentioned, most of those who need those extras will most likely be unemployed and on Medicaid or possibly uninsured and without finances to pay the extras, so why charge extra for the ambulance? If the person does have insurance, then the company will end up raising the premium for all customers as a way to keep its profit margin on the incline.

As for your plight of having long legs which you feel need to be covered, you can either blame your parents for giving you tall genes, or learn to wear hot pants and mini-skirts. Many men-and quite a few women as well-would be pleased by the sight. Better yet, so you don't have to worry about paying extra, put on a pair of go-go boots which will cover the area the pants can't. See? Problem solved-I really should go into fashion consulting, I have so much to offer:biggrin1:.

Our value as humans should not be measured in monetary costs at a public level. Utilitarianism is an unethical basis for a society and even Bentham admitted as such. Same goes for oligarchy and aristocracy.

The best part about aristocracy though is that they tend to lose their heads when the shit hits the fan.

My apologies to the Marquis and other real aristocrats who visit this board for that comment. It was not meant with malice.

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Oh I agree, but as it stands it does cost money. I think ambulances should be a public service, not subject to bills and the like, but it is.

ok here we go...i am an EMT in a rural community and we charge a flat rate and then the extra cost is how far we have to go an get the person and then the miles to the hospital if the person is out in the country. I agree that it should be free in some instances but if it werent for the charges how would the ambulance company get the money to buy the equipment to dave your life? The EMTs theirselves cant buy the equipment becuase if you look at the cost of medical supplies, its outragous(sP)!! We just got a new cot for our two ambulances and that alone cost $25,000.00 I am serious as a heart attack. The stuffwe need isn't cheap so that is the reason behind sending out bills for our services!